Introduction Seasonal influenza (SI) vaccination has been recommended for healthcare workers (HCWs) for many years. Despite decades of efforts to encourage HCWs to be immunised, vaccination uptake levels remain low. Most voluntary policies to increase vaccination rates among HCWs have not been very effective. How to close the gap between desired and current vaccination rates, that’s the question. Whether (semi)mandatory vaccination policies (e.g., vaccination-required, vaccinate-or-mask, ‘may not work during facility outbreaks’ policies) are justified is an ethical issue.
Methods We explored the ethical, moral, empirical and evidential arguments for or against (mandatory) SI vaccination of HCWs in the literature (2011–2017). Neither the ‘clinical’ nor the ‘public health’ ethics frameworks resolve the question fully. Are the ‘medical ethical principles’ of beneficence (an action done to benefit others) and non-maleficence (one ought not to inflict evil or harm) sufficient enough to support mandatory influenza vaccination policies?
Results Recently ‘components of justice’ frameworks were also added to the ungoing ethical debate. HCWs remain bound by ethical principles of both beneficence and non-maleficence. It is very unlikely that purely voluntary programmes will achieve vaccination rates among HCWs that are sufficient to meet the ethical obligations of beneficence and non-maleficence. Although there is increasing evidence, that individuals are more inclined to get vaccinated if this benefits other, if their own costs are low.
Further studies documenting the impact of HCWs influenza vaccination outcomes on the patients’ health, would inform decisions on the use of mandatory vaccine policies in HCWs. Despite the ongoing debate about the evidence, some governments and health care organisations have judged that the scientific evidence is sufficiently strong to justify (semi)mandatory vaccination policies for HCWs.
Discussion Garning early and broad-based support from employers, employees, governmental administration, human resources, and occupational health appears to be important for development of a SI vaccine mandate.
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